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Meta-Analysis
. 2010 Aug 23:341:c3995.
doi: 10.1136/bmj.c3995.

Nurse led interventions to improve control of blood pressure in people with hypertension: systematic review and meta-analysis

Christopher E Clark  1 , Lindsay F P Smith, Rod S Taylor, John L Campbell
Affiliations
Meta-Analysis

Nurse led interventions to improve control of blood pressure in people with hypertension: systematic review and meta-analysis

Christopher E Clark et al. BMJ. .

Abstract

Objective: To review trials of nurse led interventions for hypertension in primary care to clarify the evidence base, establish whether nurse prescribing is an important intervention, and identify areas requiring further study.

Design: Systematic review and meta-analysis.

Data sources: Ovid Medline, Cochrane Central Register of Controlled Trials, British Nursing Index, Cinahl, Embase, Database of Abstracts of Reviews of Effects, and the NHS Economic Evaluation Database.

Study selection: Randomised controlled trials of nursing interventions for hypertension compared with usual care in adults.

Data extraction: Systolic and diastolic blood pressure, percentages reaching target blood pressure, and percentages taking antihypertensive drugs. Intervention effects were calculated as relative risks or weighted mean differences, as appropriate, and sensitivity analysis by study quality was undertaken.

Data synthesis: Compared with usual care, interventions that included a stepped treatment algorithm showed greater reductions in systolic blood pressure (weighted mean difference -8.2 mm Hg, 95% confidence interval -11.5 to -4.9), nurse prescribing showed greater reductions in blood pressure (systolic -8.9 mm Hg, -12.5 to -5.3 and diastolic -4.0 mm Hg, -5.3 to -2.7), telephone monitoring showed higher achievement of blood pressure targets (relative risk 1.24, 95% confidence interval 1.08 to 1.43), and community monitoring showed greater reductions in blood pressure (weighted mean difference, systolic -4.8 mm Hg, 95% confidence interval -7.0 to -2.7 and diastolic -3.5 mm Hg, -4.5 to -2.5).

Conclusions: Nurse led interventions for hypertension require an algorithm to structure care. Evidence was found of improved outcomes with nurse prescribers from non-UK healthcare settings. Good quality evidence from UK primary health care is insufficient to support widespread employment of nurses in the management of hypertension within such healthcare systems.

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Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any company for the submitted work; no financial relationships with any companies that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Flow of papers through study
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Fig 2 Change in systolic blood pressure with nurse led use of algorithm compared with usual care
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Fig 3 Changes in blood pressure with interventions including nurse prescribing compared with usual care
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Fig 4 Absolute systolic blood pressure after nurse led telephone monitoring compared with usual care
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Fig 5 Absolute systolic blood pressure after community nurse led interventions compared with usual care for good quality studies
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Fig 6 Changes in blood pressure with primary care nurse led clinics compared with usual care
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Fig 7 Systolic blood pressure readings for participants from ethnic minority groups
See this image and copyright information in PMC

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